嬰兒感染用抗生素附加 Zinc 效果比較好!!

Zinc
Plus Antibiotic Reduces Treatment Failure in Infants

Joe
Barber Jr, PhD

May
31, 2012 — Infants with probable serious bacterial infection who received zinc
in addition to standard antibiotic therapy were less likely to suffer treatment
failure, according to the findings of a randomized, double-blind, placebo-controlled
trial.

Shinjini
Bhatnagar, PhD, from the All India Institute of Medical Sciences in New Delhi
and the Translational Health Science and Technology Institute in Gurgaon,
Haryana, India, and colleagues published their findings online May 31 and in the
June 2 print issue of the Lancet.

The
authors state that the current treatments for infants with severe infections
are less than optimal. "Despite advances in antimicrobial treatment,
outcomes remain poor," the authors write. "Development of inexpensive
and accessible interventions that could improve treatment outcomes and reduce
case fatality is important."

To
assess the effect of zinc supplementation on treatment success, Dr. Bhatnager
and colleagues screened infants aged from 7 to 120 days at 3 hospitals in New
Delhi between July 6, 2005, and December 3, 2008, for convulsions, fast
breathing, severe chest indrawing, and other signs of serious bacterial
infection. They then randomly assigned 700 patients to receive either zinc (352
patients, 332 assessed for treatment failure) or placebo (348 patients, 323
assessed for treatment failure) in addition to standard antibiotic care
(ampicillin and an aminoglycoside, third-generation cephalosporin and an
aminoglycoside, or intravenous cloxacillin). Overall, the investigators saw a
40% reduction in the risk for treatment failure in the zinc supplementation
group compared with the placebo group (95% confidence interval [CI], 10% - 60%;
P = .0113).

The
researchers included preterm infants (gestational age ≤ 32 weeks) who were
older than 2 months at screening. They excluded infants weighing 1500 g or
less; those requiring mechanical ventilation, inotropic drugs, or exchange
transfusion; those with any serious underlying medical condition; those born to
HIV-infected mothers; and those who received zinc during the present infective
episode. The primary outcome of the trial was treatment failure (defined as a
need to change antibiotics within 7 days of randomization, a need for intensive
care, or death at any time within 21 days after randomization); the secondary
outcomes included clinical time to recovery, time to achieve exclusive oral
feeding, time to weight gain, and time to overall recovery.

No
differences were observed in the baseline characteristics of the placebo and
zinc supplementation groups. In a subgroup of patients aged from 7 to 60 days,
zinc supplementation reduced the incidence of treatment failure by 54% (95% CI,
20% - 74%; P = .0045).

Zinc
had a greater effect in infants with diarrhea than in those without diarrhea
(risk ratio [RR], 0.85 [95% CI, 0.52 - 1.39] vs 0.31 [95% CI, 0.14 - 0.65],
respectively; P = .0260), but no difference in treatment efficacy was
observed between underweight and nonunderweight patients (RR, 0.46 [95% CI,
0.21 - 0.98] vs 0.68 [95% 0.43 - 1.08], respectively; P = .0378).

However,
the researchers caution that additional research is necessary before zinc can
be applied clinically to prevent treatment failure. "Future trials need to
measure the efficacy of zinc treatment for probable serious bacterial infection
in other settings — specifically, other studies should measure the effect of
zinc supplementation on important outcomes in children who are diagnosed with serious
bacterial infections without measurements of concentrations of C-reactive
protein," the authors write. "If such trials show improvement in
treatment outcomes, the use of zinc as an adjunct to antibiotic treatment might
lead to substantial reductions in infant mortality, particularly in
resource-constrained settings where second-line antibiotics and appropriate
intensive care might be unavailable."

In
a related commentary, Christa L. Fischer Walker, PhD, MHS, and Robert E. Black,
MD, MPH, say they are encouraged by these findings but agree that additional
research is necessary. "Bhatnagar and colleagues' promising results will
need to be replicated before practical recommendations can be made," Dr.
Fischer Walker and Dr. Black write. "The exact mechanism for the effect of
supplemental zinc is unknown and needs further investigation, but the clinical
benefits in diarrhoea and pneumonia in children younger than 5 years, and now
in probable serious infections in young infants, suggest that therapeutic use of
zinc could have wide application."

The
authors and commentators have disclosed no relevant financial relationships.

Lancet.
Published online May 31, 2012.

Medscape Medical News © 2012 WebMD,
LLC

 

治療Clostridium difficile感染的 fidaxomycin (DIFICID)

DIFICID is a macrolide antibacterial drug indicated in adults ≥18 years
of age for treatment of Clostridium difficile-associated diarrhea.

To reduce the
development of drug-resistant bacteria and maintain the effectiveness of
DIFICID and other antibacterial drugs, DIFICID should be used only to treat
infections that are proven or strongly suspected to be caused by Clostridium
difficile.

 

About C. difficile-associated Diarrhea (CDAD)

C. difficile is a
spore-forming, gram-positive anaerobe¹

• C. difficile produces two toxins, A and B, which
  activate the release of cytokines from monocytes²

• Toxins A and B lead to inflammation, intestinal
  epithelial cell damage, fluid secretion, and diarrhea, as well as other
  symptoms³

Transmission of C.
difficile⁴

• The primary mode of transmission is person-to-person
  spread through the fecal-oral route


• Environmental contamination also plays an important
  role (eg, commodes, bedpans, thermometers, etc)

Pathogenesis of C.
difficile^3,5

• C. difficile-ingested spores are able to survive the
  acidic stomach


• Spores reach the small intestine and germinate to
  vegetative form


• If intestinal microflora is disrupted, C. difficile can
  proliferate

• Toxigenic strains of C. difficile may produce clinical
  disease

C. difficile: a persistent pathogen

• C. difficile spores can be stable for months and
  cultured from hospital surfaces (eg, railings, bedpans, walls, floors,
  sinks, etc)⁴




• Spores are resistant to antibacterial soaps,
  alcohol-based hand sanitizers, and conventional disinfectants⁴




• The vegetative form of C. difficile can survive in the
  environment on moist surfaces for up to 6 hours⁵




• Vegetative form is susceptible to gastric acid,
  antibacterial soaps, and alcohol-based hand sanitizers⁶




• Formation of spores and the inadequacy of standard
  methods of disinfection (not killed by conventional detergents or
  solvents) lead to persistence in the environment and the spread of
  infection⁴

• Disinfection requires bleach or other strong oxidizers
  (eg, peroxide), extreme heat (greater than the boiling point of water), or
  long contact times⁷




• CDC recommends meticulous cleaning followed by use of
  hypochlorite-based germicides for desinfection of surfaces in
  patient-care areas⁷

Appr

Approximately 700,000 new cases per year in the United States^5,6

·        
CDI accounts for
significant rates of morbidity and mortality that increase with patient age,
with a mortality rate as high as 14% in elderly patients⁷

·        
According to the CDC,
CDI rates increased 200% for hospitalized patients aged ≥65 years from 1996 to
2009⁸

·        
C.
difficile has surpassed
methicillin-resistant Staphylococcus aureus (MRSA) as the leading cause
of healthcare-acquired infections in community hospitals⁹

·        
C.
difficile is the most common
cause of infectious diarrhea in healthcare settings¹⁰

·        
CDAD is the most
common symptom of CDI¹⁰

Efficacy of DIFICID

DIFICID has primary
activity against species of clostridia, including C. difficile in vitro¹

• Bactericidal against C. difficile in vitro¹


• Minimal inhibitory concentration (MIC₉₀) =
  0.25 μg/mL^2,3




• MIC range: 0.03-0.25 μg/mL¹

• Inhibits bacterial RNA polymerase¹


• Demonstrates no cross-resistance with other classes of
  antibacterial drugs in vitro¹


• Demonstrates a post-antibiotic effect versus C.
  difficile of 6-10 hours in vitro¹

DIFICID ACTS LOCALLY IN
THE

GASTROINTESTINAL TRACT¹

 

DIFICID is mainly
confined to the GI tract¹

• Acts locally in the gastrointestinal tract against C.
  difficile


• Plasma concentrations were minimal, in the ng/mL range
  (ranging from 2-179 ng/mL within the T_max window [1-5 hours])


• Fecal concentrations in samples collected within 24 hrs
  of the last dose ranged from 639-2710 μg/g

 

Safety and
Dosing of DIFICID

Important Safety Information

·        
DIFICID should not be
used for systemic infections

·        
Only use DIFICID for
infection proven or strongly suspected to be caused by C. difficile.
Prescribing DIFICID in the absence of a proven or strongly suspected C.
difficile infection is unlikely to provide benefit to the patient and
increases the risk of the development of drug-resistant bacteria

·        
The most common
adverse reactions are nausea (11%), vomiting (7%), abdominal pain (6%),
gastrointestinal hemorrhage (4%), anemia (2%), and neutropenia (2%)

For more information,
please visit www.DIFICID.com

Mechanism of Action of DIFICID

DIFICID is the first bactericidal therapy in more than 25 years
that targets C. difficile¹

DIFICID has primary
activity against species of clostridia, including C. difficile, in vitro¹

·        
Bactericidal against C.
difficile in vitro¹

·        
Acts locally in the
gastrointestinal tract against C. difficile¹

·        
Demonstrates no
cross-resistance with other classes of antibacterial drugs in vitro¹

·        
Inhibits bacterial RNA
polymerase¹

DIFICID
acts locally in the gastrointestinal tract¹

 

Next article

Efficacy of
DIFICID

Important Safety Information

·        
DIFICID should not be
used for systemic infections

·        
Only use DIFICID for
infection proven or strongly suspected to be caused by C. difficile.
Prescribing DIFICID in the absence of a proven or strongly suspected C.
difficile infection is unlikely to provide benefit to the patient and
increases the risk of the development of drug-resistant bacteria

·        
The most common
adverse reactions are nausea (11%), vomiting (7%), abdominal pain (6%),
gastrointestinal hemorrhage (4%), anemia (2%), and neutropenia (2%)

Indications and Usage

·        
DIFICID is a macrolide
antibacterial drug indicated in adults ≥18 years of age for treatment of Clostridium
difficile-associated diarrhea

·        
To reduce the
development of drug-resistant bacteria and maintain the effectiveness of
DIFICID and other antibacterial drugs, DIFICID should be used only to treat
infections that are proven or strongly suspected to be caused by Clostridium
difficile

For more information, please visit www.DIFICID.com

FULL
PRESCRIBING INFORMATION

1
INDICATIONS AND USAGE

To
reduce the development of drug-resistant bacteria and maintain the

effectiveness
of DIFICID and other antibacterial drugs, DIFICID should be

used
only to treat infections that are proven or strongly suspected to be

caused
by Clostridium
difficile.

1.1 Clostridium
difficile-Associated
Diarrhea

DIFICID
is a macrolide antibacterial drug indicated in adults (³18 years of age)

for
treatment of Clostridium
difficile-associated
diarrhea (CDAD).

2
DOSAGE AND ADMINISTRATION

The
recommended dose is one 200 mg DIFICID tablet orally twice daily for

10 days
with or without food.

3
DOSAGE FORMS AND STRENGTHS

200 mg
white to off-white film-coated, oblong tablets; each tablet is debossed

with ²FDX² on one
side and ²200² on the
other side.

4
CONTRAINDICATIONS

None.

5
WARNINGS AND PRECAUTIONS

5.1 Not
for Systemic Infections

Since
there is minimal systemic absorption of fidaxomicin, DIFICID is not

effective
for treatment of systemic infections.

5.2
Development of Drug Resistant Bacteria

Prescribing
DIFICID in the absence of a proven or strongly suspected C.
difficile

infection
is unlikely to provide benefit to the patient and increases the
risk of the development of drug resistant bacteria.

6
ADVERSE REACTIONS

6.1
Clinical Trials Experience

Because
clinical trials are conducted under widely varying conditions, adverse

event
rates observed in the clinical trials of a drug cannot be directly compared

to
rates in the clinical trials of any other drug and may not reflect the rates

observed
in practice.

The
safety of DIFICID 200 mg tablets taken twice a day for 10 days was

evaluated
in 564 patients with CDAD in two active-comparator controlled trials

with
86.7% of patients receiving a full course of treatment.

Thirty-three
patients receiving DIFICID (5.9%) withdrew from trials as a result

of
adverse reactions (AR). The types of AR resulting in withdrawal from the

study
varied considerably. Vomiting was the primary adverse reaction leading

to
discontinuation of dosing; this occurred at an incidence of 0.5% in both the

fidaxomicin
and vancomycin patients in Phase 3 studies.

 

維他命D缺乏孩童常因中耳炎而鼓膜破洞

Vitamin D Deficiency Linked With Eardrum Perforation Risk

Nancy A. Melville

May 29, 2012 (Thessaloniki, Greece) — Although vitamin D deficiencies in children show no strong link to a greater risk for recurrent acute otitis media (RAOM), the deficiency does show a significant association with repeated tympanic membrane perforation (RTMP) related to otitis media, according to research presented here at the European Society for Paediatric Infectious Diseases (ESPID) 30th Annual Meeting.

Vitamin D has been shown in previous studies to have immunomodulatory effects, and vitamin D deficiency can increase the risk for respiratory infections.

To further explore the role of vitamin D deficiency in RAOM, a research team led by Susanna Esposito, MD, from the Department of Maternal and Pediatric Sciences at the University degli di Milano, Italy, evaluated 128 children with a documented history of RAOM.

The children (mean age of 35.7 ± 19.8 months) had blood samples with levels of 25-hydroxyvitamin D (1,25[OH]2D3) drawn 28 to 30 days after their last episode of the ear infection.

Researchers factored in the number of older siblings, pacifier use, day care attendance, and exposure to passive smoking.

The results showed vitamin D levels less than 20 ng/mL for 39 (30.5%) of the 128 patients. Levels were 20 to 30 ng/mL in 34 (26.6%) children and greater than 30 ng/mL in 55 (42.9%) children.

The association between RAOM and vitamin D level was not significant in the unadjusted or in the multivariate model; however, a separate analysis of children with RTMP showed the condition to be significantly inversely associated with level of vitamin D in the multivariate model (β = -0.002; P = .03).

The risk for RTMP was associated with a vitamin D level less than 30 ng/mL.

"Vitamin D deficiency seems to be an independent and additive risk factor for the development of RAOM with RMTP," the authors concluded. "These data suggest that in children with RAOM and RTMP, vitamin D level has to be determined and vitamin D supplementation could be considered."

Dr. Esposito said her team was motivated to evaluate the role of vitamin D in a variety of potential mechanisms that could play a role in otitis media–related eardrum perforation.

"Vitamin D rules macrophages' and dendritic cells' activities," she told Medscape Medical News. "Indeed, 1,25(OH)2D3 stops the lipopolysaccharide capacity to induce IL-1b expression, as many antimicrobial genes do."

"Vitamin D also induces expression of catelecidin and ?-defensin, which are antimicrobial peptides widely expressed in the organism, that play a key role in the innate immunity, through their chemotactic action and toxin neutralization," she explained.

"Finally, vitamin D [induces] adaptative shifts in the expression of cytokine from Th1 toward a Th2 profile. So, for this reason, we decided to evaluate whether children with recurrent AOM had lower values than healthy children."

"We demonstrated that this was true, especially in those with perforation who have the most severe episodes, so the next step is to evaluate whether supplementation with vitamin D in these children reduces episodes of perforation."

According to Petri Koponen, MD, a research with the Paediatric Research Centre at Tampere University Hospital, Finland, the findings offer an intriguing look at the role of vitamin D in otitis media.

"I do think there is some [other] evidence of immunoregulatory effects of vitamin D, so I think this was a very interesting study," said Dr. Koponen, who also presented at the meeting.

Dr. Esposito and Dr. Koponen have disclosed no relevant financial relationships.

European Society for Paediatric Infectious Diseases (ESPID) 30th Annual Meeting. Abstract #469. Presented May 22, 2012.

Medscape Medical News © 2012 WebMD, LLC

Nurse Practitioners的加入可以改善癌症病患的生活品質

Nurse Practitioner Intervention Affects Cancer Patient QOL

Roxanne Nelson

May 30, 2012 — A consultative visit with a nurse practitioner improves the quality of life of patients with metastatic cancer, according to a small study published online May 4 in the Journal of Palliative Medicine. Patients who received this intervention showed significant improvements in their emotional and mental wellbeing.

On the emotional domain of the Functional Assessment of Cancer Therapy-General (FACT-G) scale, an assessment tool that has been widely used and prospectively validated as a measure of quality-of-life end points, there was a statistically significant improvement in the intervention group, compared with the control group (P = .0106).

However, there were no statistically significant differences on the other FACT-G domains between the 2 study groups.

On the Linear Analogue Self Assessment scale (LASA), a 12-question survey designed to assess quality-of-life parameters on a scale of 1 to 10, changes from baseline mental quality of life were statistically better in the intervention group than in the control group (19 vs –10; P = .02).

Simple Measure Brings Improvement

"A relatively simple consultation visit, that took anywhere from 30 to 60 minutes, with the nurse practitioner resulted in an improvement in the patient's quality of life," said senior author Gerardo Colon-Otero, MD, an oncologist in the division of hematology/oncology at the Mayo Clinic in Jacksonville, Florida.

The purpose of the intervention was to bring palliative care to the patients, he explained in a Mayo Clinic video. Palliative treatments usually involve a large team of professionals, but community acceptance is frequently less than optimal. This is primarily because of the lack of access to these services and the fact that physicians do "not really have the time to address the patient's psychological and social needs," Dr. Colon-Otero explained.

He noted that this was the first attempt at an intervention in which the nurse practitioner spoke with the patients about hospice and end-of-life wishes and assessed their quality of life and needs. It "resulted in the patients' quality of life improving when it was measured a month later," said Dr. Colon-Otero.

"The findings should be extremely helpful to oncologists, in both community and academic medical practices, concerned about how to incorporate palliative care, including discussions about advanced directives in the outpatient management of their cancer patients," he explained in a statement.

In their study, Dr. Colon-Otero and colleagues point out that in many cases, patients overestimate their chances for survival; this can lead them to resist interventions focused on the palliation of symptoms. In addition, academic medical centers and private oncology practices often do not offer ongoing care and support after hospice enrollment. Patients and/or their families might therefore be reluctant to use hospice services because of a strong attachment to their current caregivers and a "perceived sense of abandonment."

Physicians might be reluctant to discuss hospice with patients, they note, because explaining that a treatment is futile or no longer effective is difficult. They might also feel that the patient will not be understanding of or receptive to the idea of palliative care or hospice. As a result, patients often end up enrolling in hospice care much too late and do not complete advanced directives in a timely fashion.

Study Details

In this randomized phase 2 trial, Dr. Colon-Otero and colleagues assigned 26 patients with metastatic cancer to intervention with a nurse practitioner or to the control group. The study was designed enroll 100 patients, but accrual was halted after the first 26 patients because other recently completed randomized studies showed the benefit of nurse-driven palliative interventions.

The control group completed questionnaires about hospice care and quality-of-life tools, including the FACT-G and LASA scales, at baseline and 1 month later (or at the time of hospice referral, if that occurred earlier). This group had access to palliative care consultations and hospice referrals, determined by their oncology team.

Those in the intervention group completed the questionnaires and had an initial and a 1-month follow-up consultation with an oncology nurse practitioner who informed them about hospice care, helped fill out the Five Wishes and living will forms, and assessed their psychological, physical, intellectual/cognitive, social, and spiritual needs.

The "success of this study brings a simple way to introduce advanced directives discussions and symptom assessment early in the clinical course of metastatic cancer patient care by a professional...who is part of the oncology team," the authors write.

Advanced care planning and informed discussions about end-of-life issues were well received by patients, despite it being early in their clinical course of metastatic cancer, they add.

"In the future, we plan to explore the use of this intervention in broader study populations, with special attention to underserved and minority subgroups, given the reports of underutilization and decreased awareness of palliative care and hospice services in this subpopulation," the authors conclude.

The authors have disclosed no relevant financial relationships.

J Palliat Care. Published online May 4, 2012. Abstract

Medscape Medical News © 2012 WebMD, LLC

維他命D過少很不好；但過多也不可以

 

維他命D過多 死亡率可能增加 【00:35】

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．有頭蒼蠅

〔中央社〕研究人員警告，血液中的維他命D濃度過多與死亡率高有關。他們在「出人意外」的研究結果中聲稱，過多的維生素D，造成的傷害幾乎跟過少一樣。

丹麥研究人員進行的新研究發現，維他命D濃度相當高的人，死亡率會高出40%。

這項哥本哈根大學（University of Copenhagen）研究，是根據24萬7574位病人的血液樣本。他們的血液樣本是經由家庭醫師檢測。

不過，英國專家表示，英國有相反的問題，目前有1/4的民眾維他命D濃度低，可能有不足的危險。

這項研究是使用哥本哈根家庭醫師實驗室（Copenhagen General Practitioners Laboratory）血液樣本中，規模最大的一個。

研究發現，維他命D降至最低濃度和升至最高濃度時，與死亡率變高其間的關連性。

研究結果顯示，當血液中每公升的血清含有不到10nmol（10億分之一莫耳）的維他命D，死亡率就會增加超過1倍，是平均值的2.31倍高。

不過，如果血液中每公升的血清含有超過140nmol的維他命D，死亡率會多出1.42，大約高出40%。

發表在「臨床內分泌與代謝期刊」（Journal of Clinical Endocrinology and Metabolism）的研究報告說，維他命D含量為50nmol時，死亡率最低。

Sun Exposure Not Enough to Correct Vitamin D Deficiency

Kate Johnson

March 17, 2012 (San Diego, California) — "The 'epidemic' in vitamin D deficiency is clearly not from too little sun exposure," and dermatologists can be confident in insisting that their patients continue their sun protection efforts, said Richard Gallo, MD, PhD, here at the American Academy of Dermatology (AAD) 70th Annual Meeting.

"Clearly solar exposure is an influence — there is no doubt about that — but you cannot predictably say that a certain amount of exposure will normalize vitamin D deficiency," said Dr. Gallo, chief of dermatology and professor of medicine and pediatrics at the University of California, San Diego, in an interview with Medscape Medical News.

Speaking to an overcapacity audience at the meeting's "Hot Topics" symposium, Dr. Gallo, who was involved in the 2010 Institute of Medicine's (IOM's) consensus report on updated dietary vitamin D intake recommendations, said that although "sunlight is a very reliable source of vitamin D, nutritional sources are clearly required and are, of course, much safer."

He said although there is strong evidence that vitamin D is "absolutely necessary" for bone health, other potential health benefits such as protection from cardiovascular events, cancer, and infection are, as yet, unproven.

Although some physicians advocate universal screening for vitamin D deficiency or insufficiency, Dr. Gallo said there is no evidence to support this approach, and there is a lack of consensus on the definition of these conditions.

The IOM report recommends that patients should have serum vitamin D levels above 20 ng/mL, but the American Endocrine Society sets this level at 30 ng/mL, Dr. Gallo said.

There is evidence to support screening in high-risk individuals, he added, and noted that this is an extensive list including all dark-skinned, pregnant or lactating, elderly, and obese individuals, as well as those with malabsorption syndromes, rickets, osteomalacia, osteoporosis, chronic kidney disease, granulomatous disorders and lymphomas, and patients receiving chronic antifungal therapy.

"This is a pretty broad spectrum of individuals, and it's kind of left up to the individual practitioner right now to use their common sense regarding who should be screened and who shouldn't," Dr. Gallo noted. Physicians who do find a deficiency on screening should consider checking parathyroid hormone, which can sometimes have a compensatory rise, he said.

"An elevated parathyroid hormone paired with low vitamin D and potentially low calcium could be high risk for bone disease. So those kinds of individuals on the severe [low] end you might be best to refer to an endocrinologist," he said in the interview.

"For individuals on the borderline, at 15 ng/mL (and a lot of individuals are there) a simple thing to do is to just suggest a vitamin supplement and rescreen them perhaps 3 to 6 months later."

Winter blood tests will naturally reflect lower levels than in the summer, he added.

Dr. Gallo have disclosed no relevant financial relationships.

American Academy of Dermatology (AAD) 70th Annual Meeting: Presented March 16, 2012.

Medscape Medical News © 2012 WebMD, LLC

美國的中國專家評估中國的將來--問題還很深沉!

[基本人性品德、社會道德水準的問題，三十、五十年內不可能改善。經濟問題更是焦眉之急。]

中國文化很好嗎?

Is Chinese culture good for humans?

Thursday, May 31, 2012

逾九成中共中央委員親屬移居海外

高官紛紛把子女送往歐美, 或移轉財產

9成中共中委 親屬居海外



香港新聞組香港27日電

May 28, 2012 06:01 AM | 23043 次 | 0 | 37 | |

中國大陸官員家屬移民境外，被指是「裸官」。香港雜誌「動向」引述消息來源披露，中央最近曾展開一項內部調查，結果發現竟有逾九成的中共中央委員，包括子女、孫子孫女和兄弟姊妹等直系親屬已移居海外。

香港「東方日報」根據「動向」報導，大陸官方內部權威機構統計數據所指，截至今年3月底，第17屆中央委員會之中，204名中央委員中，187人有直系親屬在歐美等西方國家居住、生活、工作或已經加入所在國國籍，占91%；167名候補委員中，則有142人親屬已移居海外，佔85%；127名中紀委委員中，有113人親屬已移居海外。



報導還引述美國政府的統計數據稱，中國部級以上的官員(包含已退位)的兒子輩75%擁有美國綠卡或公民身分，孫子輩有美國公民身分達到91%或以上。



美國媒體紐約時報及華盛頓郵報最近連續報導指，中共高官紛紛把子女送往歐美名校就讀，或是移轉財產。另有專家學者分析認為這是中共高官自己都對中國的未來沒有信心。



Read more: 世界新聞網-北美華文新聞、華商資訊 - 9成中共中委 親屬居海外

May 20, 2012

In China, Fear at the Top

By RODERICK MacFARQUHAR

IN the heyday of the
Soviet era, Communist leaders were described by the dissident Yugoslav theorist
Milovan Djilas as the “New Class,” whose power lay not in ownership of wealth
but in control of it: all the property of the state was at their beck and call.
There was the apocryphal but appropriate story of Brezhnev’s showing his humble
mother around his historic office, his magnificent collection of foreign luxury
cars and his palatial dacha with its superb meals, and asking for her
impressions — to which she replied: “It’s wonderful, Leonid, but what happens
if the Bolsheviks come back?”

But if even a fraction of the stories about the wealth and
lifestyles of China’s “princelings” — the descendants of Mao’s revolutionary
generation — are to be believed, China’s New Class wants not only control, but
also ownership. Few of China’s netizens are likely to believe that Bo Xilai,
the Politburo member and party boss of the mega-city of Chongqing who was
ousted in March on corruption charges, was an aberration.

Why has ownership of wealth become so important for the Chinese
elite? And why have so many Chinese leaders sent their children abroad for
education? One answer surely is that they lack confidence about China’s future.

This may seem strange, given that the Chinese have propelled their
country into the top ranks of global economic powerhouses over the past 30
years. There are those who predict a hard landing for an overheated economy —
where growth has already slowed — but the acquisition of wealth is better
understood not just as an economic cushion, or as pure greed, but as a
political hedge.

China’s Communist leaders cling to Deng Xiaoping’s belief that
their continuance in power will depend on economic progress. But even in China,
a mandate based on competence can crumble in hard times. So globalizing one’s
assets — transferring money and educating one’s children overseas — makes sense
as a hedge against risk. (At least $120 billion has been illegally transferred
abroad since the mid-1990s, according to one official estimate.)

Mao and his colleagues had a self-confidence born of many factors:
triumph in civil war; a well-organized party apparatus; a Marxist-Leninist
ideological framework, the road map to a socialist future; and the bulwark of
the victorious People’s Liberation Army. Today, more than 60 years after the
civil war, only the P.L.A. looks somewhat the same, and the self-confidence is
fraying.

The denunciations of party leaders and officials by the Red Guards
during the Cultural Revolution undermined the party’s authority and legitimacy.
The party’s insecurity was accentuated by Deng’s rejection (in practice) of
Marxism-Leninism. The cloak of ideological legitimacy was abandoned in the race
for growth.

Today, the party’s 80 million members are still powerful, but most
join the party for career advancement, not idealism. Every day, there are some
500 protests, demonstrations or riots against corrupt or dictatorial local
party authorities, often put down by force. The harsh treatment that prompted
the blind human-rights advocate Chen
Guangcheng to seek American protection is only one of the most notorious
cases. The volatile society unleashed against the state by Mao almost 50 years
ago bubbles like a caldron. Stories about the wealth amassed by relatives of
party leaders like Mr. Bo, who have used their family connections to take
control of vast sectors of the economy, will persuade even loyal citizens that
the rot reaches to the very top.

The Bo affair is not just about massive corruption but also
succession. Mr. Bo had developed a high-profile “Chongqing model” characterized
by crime busting, Maoist singalongs, cheap housing and other welfare
provisions. It was a populist, and popular, attempt by a charismatic
“princeling,” son of a revolutionary hero, to assert his natural right to
ascend to the nine-member Politburo Standing Committee at the 18th Chinese
Communist Party Congress later this year. Among the rumors circulating in China
is that, once on the committee, Mr. Bo would have tried to replace the party’s
incoming general secretary and president agreed to by the outgoing leadership:
Xi Jinping.

Mao, who died in 1976, hand-picked his successor. Deng, who died
in 1997, blessed Jiang Zemin and Hu Jintao to follow him. Mr. Hu, not being a
revolutionary hero like Mao or the godfather of economic reform like Deng, did
not have the prestige to appoint his successor. The low-key Mr. Xi, a
princeling like Mr. Bo, emerged as a result of jostling behind closed doors.
Lacking institutional legitimacy and a laying of hands by an elder, he might
have looked an easy target to an ambitious Mr. Bo.

In the months ahead, party leaders will use every propaganda tool
to dissipate the damage inflicted on leadership unity, party discipline and
national “harmony” by the Bo debacle. They might divert criticism from Bo by
depicting his allegedly murderous wife as China’s Lady Macbeth. But members of
China’s New Class will still worry that the revelations about elite corruption
have exposed them to the danger of the Bolsheviks coming back.

Roderick
MacFarquhar , a professor of government at Harvard, is a co-author of “Mao’s
Last Revolution.”

 

大西洋月刊:中國硬著陸

◎ 黃世澤

在美國有相當地位的《大西洋月刊》（The Atlantic Monthly）於五月廿五日網站上發表由專責經濟及商業部分副總編輯MATTHEW
O’BRIEN文章，以中國的貸款大降、四月份用電量下降、鐵路運輸量下跌，以及匯豐銀行所做的中國採購經理指數下降這幾項指標，指出中國經濟已經衰退，換言之，已經硬著陸。

《大西洋月刊》的分析並非無的放矢，MATTHEW
O’BRIEN引用維基解密所漏出一篇美國國務院關於中國副總理李克強分析中國形勢方法的電文。李克強指ＧＤＰ可以作假，但電力用量以及鐵路貨運量是作不了假，那是可以真實反映經濟情況的數據。照李克強的分析方法，中國ＧＤＰ保八、保九都是騙人。

越來越多西方國家對中國經濟預測和分析都不樂觀，中國引發下一輪金融海嘯殊不為奇。馬英九政府面對這種狀況，是否應該採取果斷態度，中止經濟上依賴中國來救的政策，重新振興台灣的本土產業，以及探索發展印度、巴西甚至俄羅斯等新興國家的可能性，這才是保住台灣不會受中國經濟風暴所波及的正確作法。（作者為居港英籍時事評論員）

 

 

Alzheimer病患在明顯失智前嗅覺逐漸喪失

A Smell Test for Alzheimer's?

Megan Brooks

May 25, 2012 – There is a large body of evidence for an association between hyposmia and Alzheimer's dementia (AD), but the predictive value of olfactory dysfunction in the development of Alzheimer's disease (AD) is uncertain, a new review of the topic concludes.

"We establish through a systematic review the lack of proven evidence that loss-of-smell tests can be used to clinically predict future AD," Cyrus A. Raji, MD, PhD, from University of Pittsburgh Medical Center Mercy Hospital in Pennsylvania, who worked on the study, told Medscape Medical News.

"It's a big public health message. This has been a huge topic in recent years, and some popular websites even promote smell tests for Alzheimer's," Dr. Raji added.

The study was published online May 2 in Laryngoscope.

Longitudinal Data

For this review, the researchers searched PubMed, Ovid, MEDLINE, EMBASE, ISI Web of Science, PsychINFO, the Cochrane Database of Systematic Reviews and the Cochrane Register of Controlled Trials for relevant studies describing the predictive value of olfactory testing for conversion to AD.

They failed to identify any randomized controlled trials on the usefulness of olfactory testing for prediction of conversion to dementia. In the 2 prospective longitudinal cohort studies they identified, hyposomia had only moderately predictive value, they say.

In 1 longitudinal study, 126 patients with mild cognitive impairment (MCI) were followed for 3-years. During this time, 33 (26%) converted to AD and 93 (74%) did not.

After adjustment for potential predictors of conversion to AD, baseline scores on the University of Pennsylvania Smell Identification Test (UPSIT) were significantly lower among AD-converters than nonconverters (25.8 vs 33.2; P < .0001). The study authors estimated that UPSIT testing had a sensitivity of 48.5% for predicting the development of AD.

In the other longitudinal study, 21 participants without AD at baseline (8 controls and 13 patients with amnestic MCI) completed the Brief Smell Identification Test 12 months after enrollment. Six of the 13 with MCI (46%) met formal criteria for AD at this time.

Those study authors did not report the conversion rate of participants with normal cognition to AD. Among the participants with baseline MCI, AD converters had worse olfactory identification scores than did nonconverters (2.33 vs 3.44), although this difference was not statistically significant. Six of the 7 nonconverting participants with MCI showed significantly lower total olfactory scores than the control group (P < .001).

Susceptible to Confounding

Dr. Raji and colleagues also identified 30 cross-sectional studies that compared participants with or without baseline MCI to patients with preexisting AD. These studies demonstrated a positive association between poorer performance on a variety of olfactory identification tests and AD.

The cross-sectional evidence "corroborates the association between hyposmia and AD but does little to validate the use of olfactory identification as a clinical screening or prognostic instrument," the investigators say. They note that both AD and hyposmia in cognitively normal adults increase in frequency with age.

"The extensive cross-sectional body of research," they add, "is particularly susceptible to confounding" because one third of these studies failed to control for age.

A simple, accurate, and inexpensive method of predicting the onset of AD "remains a valuable but elusive target for clinicians," the authors conclude.

Susan Bookheimer, PhD, professor of Cognitive Neurosciences, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, who reviewed the analysis for Medscape Medical News, made the point that loss of olfaction is a "non-specific sign of cognitive, particularly frontal lobe, impairment. It is found in Parkinson's, AD, fronto-temporal dementia, traumatic brain injury, etc."

The conclusions of the current analysis, Dr. Bookheimer said, are "appropriate, basically saying we need more studies." Overall, the currently available data for anosmia as a predictor of AD are "lacking," she added.

The authors and Dr. Bookheimer have disclosed no relevant financial relationships.

Laryngoscope. Published online May 2, 2012. Abstract

Medscape Medical News © 2012 WebMD, LLC